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Osteologie 2008; 17(03): 142-147
DOI: 10.1055/s-0037-1619860
Renale Osteopathie
Schattauer GmbH

Therapie der Hyper phosphatämie bei renaler Osteopathie

Use of phosphate binding agents to control hyperphosphatemia in dialysis patients
T.H. Ittel
1   Hanse-Klinikum Stralsund, Medizinische Klinik (Chefarzt: Prof. Dr. Thomas H. Ittel)
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Publication History

Publication Date:
28 December 2017 (online)

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Zusammenfassung

Die Therapie der Hyperphosphatämie basiert auf Phosphatbindern, adäquater Dialyse und diätetischen Maßnahmen. Neben aluminiumhaltigen Phosphatbindern, deren Einsatz mit einer erheblichen Toxizitätsproblematik belastet ist, stehen kalziumhaltige Phosphatbinder und die kalziumfreien Phosphatbinder Sevelamer und Lanthankarbonat zur Verfügung. Sevelamer scheint besonders geeignet für inzidente Dialysepatienten mit radiologisch nachweisbarem Gefäßkalk, da unter diesem Phosphatbinder weniger progrediente Gefäßverkalkungen beobachtet werden als unter Therapie mit kalziumhaltigen Phosphatbindern. Allerdings konnte bislang in kontrollierten Studien kein Nachweis erbracht werden, dass Sevelamer im Vergleich zu Kalziumacetat die kardiovaskuläre Mortalität bei prävalenten Dialysepatienten reduziert. Lanthankarbonat ist aufgrund seiner hohen Affinität zu Phosphat der effektivste aluminium- und kalziumfreie Phosphatbinder. Er ist besonders geeignet zur Reduktion einer unerwünscht positiven Kalziumbilanz unter als Phosphatbinder eingesetzten Kalziumsalzen und ist günstig für Patienten mit supprimiertem Parathormon. Daten zum Effekt auf die Progression von vaskulären Verkalkungen liegen mit Lanthankarbonat derzeit noch nicht vor.

Summary

Treatment of hyperphosphatemia with phosphate binders is an important therapeutic intervention in the management of mineral and bone disorders of chronic kidney disease. Available phosphate binding agents include aluminum compounds, that may have significant toxicity, calcium-based phosphate-binders and novel calcium-free drugs. Sevelamer hydrochloride, which lowers both phosphate and cholesterol has been shown to attenuate the progression of vascular calcification and may be especially useful in dialysis patients with prevalent calcifications. However,a large randomized study has failed to show that treatment with sevelamer versus calcium-based binders affects allcause or cardiovascular mortality in prevalent dialysis patients. Lanthanum carbonate is considereda very potent calcium-free phosphate binder with an affinity toward phosphate similar to that of aluminum, but lacking its toxicity. This review focuses on recent data that may guide the use of the diverse phosphate binding agents.

Schlüsselwörter

Phosphatbinder - Sevelamer - Lanthankarbonat - Hyperphosphatämie

Keywords

Calcium-based phosphate binders - sevelamer - lanthanum carbonate - hyperphosphatemia
 

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